Effects of hookah smoking on indoor air quality in homes

The association between risk perceptions, anxiety, and self-reported changes in tobacco and nicotine product use due to COVID-19 in May-June 2020 in Israel

BACKGROUND

Early in the COVID-19 pandemic, reports about a possible protective effect of nicotine on COVID-19 conflicted with messaging by public health organizations about increased risks of COVID-19 due to smoking. The ambiguous information the public received, combined with COVID-19-induced anxiety, may have led to changes in tobacco or other nicotine product use. This study examined changes in use of combustible cigarettes (CCs), nargila (hookah/waterpipe), e-cigarettes, and IQOS and home-smoking behaviors. We also assessed COVID-19 related anxiety and perceptions regarding changes in risk of COVID-19 severity due to smoking.

METHODS

We used cross-sectional data from a population telephone survey that was conducted in Israel in the early phase of the COVID-19 pandemic (May-June 2020) and included 420 adult (age 18+) individuals who reported having ever used CCs (n = 391), nargila (n = 193), and/or electronic cigarettes (e-cigarettes)/heated tobacco products (e.g., IQOS) (n = 52). Respondents were asked about the effect that COVID-19 had on their nicotine product use (quit/reduced use, no change, increased use). We assessed changes in product use, risk perceptions, and anxiety using adjusted multinomial logistic regression analyses.

RESULTS

Most respondents did not change their frequency of product use (CCs: 81.0%, nargila: 88.2%, e-cigarettes/IQOS: 96.8%). A small percentage either decreased use (CCs: 7.2%, nargila: 3.2%, e-cigarettes/IQOS:2.4%) or increased use (CCs:11.8%, nargila:8.6%, e-cigarettes/IQOS:+ 0.9%). 55.6% of respondents used a product in the home prior to COVID-19; but during the first lockdown COVID-19 period, a greater percentage increased (12.6%) than decreased (4.0%) their home use. Higher levels of anxiety due to COVID-19 were associated with increased home smoking (aOR = 1.59, 95% CI:1.04-2.42, p = 0.02). Many respondents believed that increased severity of COVID-19 illness was associated with CCs (62.0%) and e-cigarettes/vaping (45.3%), with uncertainty about the association being lower for CCs (20.5%) than for vaping (41.3%).

CONCLUSIONS

While many respondents believed that nicotine product use (particularly CCs and e-cigarettes) was associated with increased risk of COVID-19 disease severity, the majority of users did not change their tobacco/nicotine use. The confusion about the relationship between tobacco use and COVID-19 calls for clear evidence-based messaging from governments. The association between home smoking and increased COVID-19-related stress suggests the need for campaigns and resources to prevent smoking in the home, particularly during times of stress.

Effects of electronic cigarettes and hookah (waterpipe) use on home air quality

INTRODUCTION

A major site of secondhand smoke exposure for children and adults is the home. Few studies have evaluated the impact of e-cigarette or hookah use on home air quality, despite evidence finding toxic chemicals in secondhand e-cigarette aerosols and hookah smoke. We assessed the effect of e-cigarette and hookah use on home air quality and compared it with air quality in homes where cigarettes were smoked and where no smoking or e-cigarette use occurred.

METHODS

Non-smoking homes and homes where e-cigarettes, hookah or cigarettes were used were recruited in the New York City area (n=57) from 2015 to 2019. Particulate matter with diameter less than 2.5 µm (PM2.5), black carbon and carbon monoxide (CO) were measured during a smoking or vaping session, both in a 'primary' smoking room and in an adjacent 'secondary' room where no smoking or vaping occurred. Log transformed data were compared with postanalysis of variance Tukey simultaneous tests.

RESULTS

Use of hookah significantly increased PM2.5 levels compared with non-smoking homes, in both the primary and secondary rooms, while use of e-cigarettes increased PM2.5 levels only in primary rooms. Additionally, in-home use of hookah resulted in greater CO concentrations than the use of cigarettes in primary rooms.

CONCLUSIONS

Use of e-cigarettes or hookah increases air pollution in homes. For hookah, increases in PM2.5 penetrated even into rooms adjacent to where smoking occurs. Extending smoke-free rules inside homes to include e-cigarette and hookah products is needed to protect household members and visitors from passive exposure to harmful aerosols and gases.

Biomonitoring of BTEX in primary school children exposed to hookah smoke

Hookah smoking is one of the major indoor sources of benzene, toluene, ethylbenzene, and xylenes (BTEX). This study aimed to investigate the potential exposure to BTEX among primary school children, particularly those exposed to hookah smoke. This cross-sectional study was conducted in Khesht, one of the southwestern cities in Iran, in mid-June 2020. Totally, 50 primary school children exposed to hookah smoke were chosen as the case group and 50 primary school children were selected as the control group. Urinary un-metabolized BTEX was measured by a headspace gas chromatography mass spectrometry (GC-MS). Additionally, a detailed questionnaire was used to gather data and information from the students' parents. The mean levels of urinary benzene, toluene, ethylbenzene, m,p-xylene, and o-xylene were 1.44, 5.87, 2.49, 6.93, and 7.17 μg/L, respectively in the exposed children. Urinary BTEX was 3.93-folds higher in the case group than in the controls (p<0.05). Household cleaning products, the floor on which the house was located, children's sleeping place, and playing outdoors were found to be important factors in predicting urinary BTEX levels. Overall, it was found necessary to avoid indoor smoking to prevent the emission of BTEX compounds via exhaled mainstream smoke and to protect vulnerable non-smokers, especially children, from exposure to second-hand and third-hand smoke.

Effect of portable air purifier on indoor air quality: reduced exposure to particulate matter and health risk assessment

We sought to investigate the impact of air purifiers in the removal of particular matter (PM)₁₀, PM_2.5, PM_1, and particle number concentration (PNC) in the indoor air of dormitories located at Iran's largest medical university, Tehran University of Medical Sciences. Twelve rooms were selected and randomly assigned to two rooms: sham air purifier system deployed room (SR) and true air purifier system deployed room (TR). All study samples were drawn simultaneously from assigned rooms using portable GRIMM dust monitors for 24 h. The PM monitors of air were positioned in the middle of each room next to the air purifier at the height of the breathing zone (1.5 m in height). The mean PM₁₀, PM_2.5, PM₁, and PNC removal efficiency in rooms with and without a smoker were measured to be 40.7 vs 83.8%, 31.2 vs 78.4%, 29.9 vs 72.3%, and 44.3 vs 75.6%, respectively. The results showed that smoking is an important influencing factor on the indoor air quality; smoking lowered the removal efficiency of PM₁₀, PM_2.5, PM₁, and PNC by 43%, 47%, 43%, and 31%, respectively. An air purifier could decline the PM₁₀ and PM_2.5 even lower than the WHO 24-h guideline level in non-smoker rooms. This study revealed that using household air purifiers in rooms with smokers and non-smokers significantly reduces the non-carcinogenic risks of exposure to PM₁₀ and PM_2.5.

Bioaccessibility-based monitoring and risk assessment of indoor dust-bound PAHs collected from housing and public buildings: Effect of influencing factors

Polycyclic aromatic hydrocarbons (PAHs) bounded in indoor dust have significant effects in residents' health. Although various researches has evaluated exposure to PAHs in some indoor areas around the world, no work has been conducted on bioaccessibility of indoor PAHs in the buildings of Bushehr city. Therefore, dust samples were collected from various indoor microenvironments including residential buildings (RB), office buildings (OB), commercial buildings (CB), industrial buildings (IB), school classroom (SC), laboratory (LR), drugstores (DS), beauty salons (BS), smoking cafés (SC) and restaurants (Res) - 10 from each microenvironment. In order to determine the levels of polycyclic aromatic hydrocarbons (PAHs), bioaccessible PAHs, and sink sorption PAHS were analyzed in them. The results showed that the highest level of these contaminants was detected in SC and the lowest in Lab. The median concentration of dust-bound ΣPAHs, bioaccessible ΣPAHs, and sink sorption ΣPAHs in the SC samples were 10,890.00, 1157.92, and 297.28 ng/g, and they were 1160.00, 19.69, and 0.75 ng/g in Lab samples. The results also indicated that the ΣPAHs concentration had a negative and significant association with the ventilation rate (pvalue <0.05 in most cases), as well as a positive and significant relationship with smoking inside buildings (pvalue <0.05). The estimated daily intake (EDI) values calculated for residential buildings (RB) were higher compared to most of the other studied microenvironments. These observations can be due to the fact that people spend much more time in residential buildings (50% of the entire day) compared to occupational settings (22%). Thus, they intake more dust within a longer time, and are hence exposed to larger amounts of pollutants bound with these particles.

Secondhand smoke exposure from the indoor and outdoor shisha centers located at the perimeter of educational institutions in Malaysia: a cross-sectional study

Shisha is a centuries-old traditional smoking habit rapidly gaining popularity among the students and young adults in Malaysia. The present study evaluated secondhand smoke exposure (SHS) and characteristics of 25 indoor and 25 outdoor shisha centers (SC) operating around the educational institutes such as universities in Petaling Jaya, Malaysia. We observed a significantly higher particulate matter (PM)_2.5 concentration in indoor than outdoor SC (3595.28 μg/m³ and 65.12 μg/m³, p < 0.001, respectively). SCs are offering different flavors to attract clients and exposing students and young professionals to a significantly high concentration of SHS. Such exposures may pose a serious health risk. Therefore, policymakers need to strengthen tobacco guidelines and eliminate loopholes in the sale of shisha by enforcing comprehensive and strict smoke-free laws.

Assessing BTEX concentrations emitted by hookah smoke in indoor air of residential buildings: health risk assessment for children

Hookah smoke is one of the major indoor sources of Volatile Organic Compounds (VOCs), including Benzene, Toluene, Ethylbenzene, and Xylenes (BTEX). The present study aimed to investigate potential exposure to BTEX compounds among primary school children whose parents smoked hookah at home. BTEX concentrations in indoor air were measured in 60 residential buildings of Khesht, southwestern Iran (case = 30 and control = 30). Target compounds were sampled by charcoal tubes, and the samples were then analyzed by GC-FID. Monte Carlo simulation was used to assess the carcinogenic and non-carcinogenic risks of BTX exposure for the children aged 7-13 years. The concentrations of benzene (7.19 ± 3.09 vs. 0.82 ± 0.5 μg/m³), toluene (1.62 ± 0.69 vs. 0.3 ± 0.22 μg/m³), and xylenes (2.9 ± 1.66 vs. 0.31 ± 0.22 μg/m³) were considerably higher in the indoor air of the case houses compared with the control houses (p < 0.05). The Incremental Lifetime Cancer Risk (ILCR) of benzene for non-smoking and smoking houses were estimated 1.8 × 10^-6 and 15 × 10^-6, respectively, exceeding the recommendations of the World Health Organization (WHO) and the Environmental Protection Agency (EPA) (1 × 10^-6). Moreover, Hazard Quotients (HQs) of all BTX compounds were < 1. The indoor benzene concentration was significantly influenced by the floor at which families lived and type of the kitchen. In order to prevent children's exposure to BTX emitted by hookah, banning indoor smoking is the only way to eliminate these compounds in the indoor air.

Indoor Exposure to Selected Air Pollutants in the Home Environment: A Systematic Review

(1) Background: There is increasing awareness that the quality of the indoor environment affects our health and well-being. Indoor air quality (IAQ) in particular has an impact on multiple health outcomes, including respiratory and cardiovascular illness, allergic symptoms, cancers, and premature mortality. (2) Methods: We carried out a global systematic literature review on indoor exposure to selected air pollutants associated with adverse health effects, and related household characteristics, seasonal influences and occupancy patterns. We screened records from six bibliographic databases: ABI/INFORM, Environment Abstracts, Pollution Abstracts, PubMed, ProQuest Biological and Health Professional, and Scopus. (3) Results: Information on indoor exposure levels and determinants, emission sources, and associated health effects was extracted from 141 studies from 29 countries. The most-studied pollutants were particulate matter (PM_2.5 and PM₁₀); nitrogen dioxide (NO₂); volatile organic compounds (VOCs) including benzene, toluene, xylenes and formaldehyde; and polycyclic aromatic hydrocarbons (PAHs) including naphthalene. Identified indoor PM_2.5 sources include smoking, cooking, heating, use of incense, candles, and insecticides, while cleaning, housework, presence of pets and movement of people were the main sources of coarse particles. Outdoor air is a major PM_2.5 source in rooms with natural ventilation in roadside households. Major sources of NO₂ indoors are unvented gas heaters and cookers. Predictors of indoor NO₂ are ventilation, season, and outdoor NO₂ levels. VOCs are emitted from a wide range of indoor and outdoor sources, including smoking, solvent use, renovations, and household products. Formaldehyde levels are higher in newer houses and in the presence of new furniture, while PAH levels are higher in smoking households. High indoor particulate matter, NO₂ and VOC levels were typically associated with respiratory symptoms, particularly asthma symptoms in children. (4) Conclusions: Household characteristics and occupant activities play a large role in indoor exposure, particularly cigarette smoking for PM_2.5, gas appliances for NO₂, and household products for VOCs and PAHs. Home location near high-traffic-density roads, redecoration, and small house size contribute to high indoor air pollution. In most studies, air exchange rates are negatively associated with indoor air pollution. These findings can inform interventions aiming to improve IAQ in residential properties in a variety of settings.

Urinary metabolites of furan in waterpipe tobacco smokers compared to non-smokers in home settings in the US

OBJECTIVES

Determine uptake of furan, a potential human carcinogen, in waterpipe tobacco (WPT) smokers in home settings.

METHODS

We analysed data from a US convenience sample of 50 exclusive WPT smokers, mean age 25.3 years, and 25 non-smokers, mean age 25.5 years. For WPT smokers, data were collected at a home visit by research assistants during which participants smoked one WPT head of one brand for a mean of 33.1 min in their homes. Research assistants provided and prepared a WP for participants by weighing and loading 10 g of WPT in the WP head. At the completion of the smoking session, research assistants measured the remaining WPT. Cotinine and six furan metabolites were quantified in first morning urine samples provided on 2 consecutive days for non-smokers, and on the morning of a WPT smoking session and on the following morning for smokers.

RESULTS

WPT smokers consumed a mean of 2.99 g WPT. In WPT smokers, urinary cotinine levels increased significantly 26.1 times the following morning; however, urinary metabolites of furan did not increase significantly. Compared to non-smokers, 2 furan metabolites, N-acetyl-S-[1-(5-acetylamino-5-carboxylpentyl)-1H-pyrrol-3-yl]-L-cysteine and N-acetyl-S-[1-(5-amino-5-carboxypentyl)-1H-pyrrol-3-yl]-L-cysteine sulfoxide, were significantly higher in WPT smokers in pre and in post WPT smoking levels.

CONCLUSIONS

To enable a more rigorous assessment of furan exposure from WPT smoking, future research should determine furan concentrations in WPT smoke, quantify furan metabolites from users of various WPT brands; and extend the investigation to social settings where WPT smoking is habitually practiced.

The effects of hookah/waterpipe smoking on general health and the cardiovascular system

Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. The misperception of hookah being less harmful than cigarettes and the availability of different but "appealing" flavors are considered among the main reasons for this trend. Hookah users however are exposed to many of the same toxic compounds/by-products as cigarette users, but at dramatically higher levels, which might lead to more severe negative health effects. In fact, hookah users are at risks of infections, cancers, lung disease, and other medical conditions. Moreover, because of the overlapping toxicant/chemical profile to conventional cigarettes, hookah smoke effects on the cardiovascular system are thought to be comparable to those of conventional cigarettes. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used. Taken together, in this review of literature, we will provide insights on the negative health effects of hookah in general, with a focus on what is known regarding its impact on the cardiovascular system.

Effects of exposure to direct and secondhand hookah and e-cigarette aerosols on ambient air quality and cardiopulmonary health in adults and children: protocol for a panel study

INTRODUCTION

Use of alternative nicotine delivery systems, such as electronic cigarettes and hookahs, has increased dramatically in the USA, but limited research has been conducted on the secondhand effects of these products, especially in children. The objective of this study is to assess the cardiopulmonary effects of e-cigarette and hookah use in vaping and smoking adults, and in non-smoking/non-vaping adults and children exposed to secondhand particles and gases.

METHODS AND ANALYSIS

This study uses a pre/post design, with four groups: two control groups (non-smoking/non-vaping and cigarette smoking) and two test groups (hookah smoking and e-cigarette vaping). Participants will be recruited by household, so that each home includes one smoking or vaping adult and one non-smoking/non-vaping adult and/or child (5-18 years). Non-smoking/non-vaping homes include an adult and child who do not smoke or vape and do not live with individuals who do. Air quality measures will be completed during a household smoking or vaping session (ambient air for non-smoking/non-vaping group), while cardiopulmonary measures and biological samples will be taken directly before and after the smoking/vaping session, and again 24 hours later, for all participants. Air quality measures include carbon monoxide, black carbon, particulate matter, trace elements, nicotine and carbonyls; cardiopulmonary measures include heart rate variability, blood pressure, pulmonary function and exhaled carbon monoxide; biological samples will assess cotinine, inflammatory cytokines and biomarkers in urine, saliva and nasal mucosa.

ETHICS AND DISSEMINATION

This study was approved by the Institutional Review Board at New York University School of Medicine (s16-02226 and s17-01143). Special attention was given to the inclusion of children, who are likely significantly impacted by the use of these products at home, and thus should be included in research. Results of the study will be distributed at conferences, in peer-reviewed journals and to relevant public health authorities for use in developing policy.

Levels and health risk assessments of particulate matters (PM2.5 and PM10) in indoor/outdoor air of waterpipe cafés in Tehran, Iran

To determine the concentration of particulate matters (PM2.5 and PM10), 36 samples were collected from indoor/outdoor air of hookah cafés (HS), cigarette cafés (CS), both hookah and cigarette (HCS), and no-smoking building (NS) in Tehran City from December 2017 to March 2018. The mean ± SD of PM10 concentration in the indoor air of the cafés in terms of HS, CS, HCS, and NS sites has been 702.35, 220.20, 1156.60, and 60.12 μg/m3, while for PM2.5, the values have been 271.92, 111.80, 619.10, and 22.25 μg/m3, respectively. It was also found that the PM concentration inside the cafés was higher during weekend session (with a higher number of active smokers), than during the weekday sessions. Moreover, the PM levels in the indoor air of the cafés were considerably higher than those of the outdoors (p < 0.05). Based on path analysis, the number of "active smokers" had the highest influence on production of PM inside the cafés, followed by the tobacco type. Finally, the mean excess lifetime cancer risk (ELCR) for PM2.5 in the indoor air of cafés was observed in the range of 0.64 × 10-5-14.98 × 10-5. Also, the mean of hazard quotient (HQ) for PM2.5 and PM10 was calculated in range of 0.82-18.4 and 0.16-3.28, respectively, which corresponds to an unacceptably high risk for human health. The PM levels in the indoor air of smoking cafés in Tehran are significantly high, such that it can cause serious risks for the health of both the customers and personnel. Thus, it is necessary that suitable controlling strategies be adopted for this public health threat.

Particulate Matter Emissions of Four Different Cigarette Types of One Popular Brand: Influence of Tobacco Strength and Additives

The inhalation of particulate matter (PM) in second-hand smoke (SHS) is hazardous to health of smokers and non-smokers. Tobacco strength (amount of tar, nicotine, and carbon monoxide) and different additives might have an effect on the amount of PM. This study aimed to investigate the influence of tobacco strength or additives on PM. Four cigarette types of the brand Marlboro with different strengths and with or without additives were analyzed in comparison to the 3R4F reference cigarette. SHS was generated by an automatic environmental tobacco smoke emitter (AETSE) in an enclosed space with a volume of 2.88 m³. PM concentrations (PM10, PM2.5, PM₁) were measured with a laser aerosol spectrometer followed by statistical analysis. The two strongest Marlboro brands (Red and Red without additives) showed the highest PM concentrations of all tested cigarettes. The measured mean concentrations Cmean of PM10 increased up to 1458 µg/m³ for the Marlboro Red without additives (PM2.5: 1452 µg/m³, PM₁: 1263 µg/m³). The similarly strong Marlboro Red showed very similar PM values. The second strongest type Marlboro Gold showed 36% (PM10, PM2.5) and 32% (PM₁) lower values, respectively. The "lightest" type Marlboro Silver Blue showed 54% (PM10, PM2.5) or 50% (PM₁) lower PM values. The results indicate that the lower the tar, nicotine, and carbon monoxide amounts, as well as the longer the cigarette filter, the lower are the PM levels. An influence of additives could not be determined.

Particulate matter emissions of four types of one cigarette brand with and without additives: a laser spectrometric particulate matter analysis of secondhand smoke

OBJECTIVE

Inhaled particulate matter (PM) in secondhand smoke (SHS) is deleterious for smokers and non-smokers. Different additives in cigarettes might effect the amount of PM. This study aimed to assess the influence of additives on the PM emissions from different cigarette types in SHS.

DESIGN

An experimental study of PM measuring in SHS of cigarettes without exposition of any person.

METHOD

The concentrations of PM (PM10, PM2.5 and PM1) in SHS of four different types of cigarettes of the brand Lucky Strike, two types with additives (Original Red, Original Blue) and two types without additives (Straight Red, Straight Blue), in comparison to the reference cigarette 3R4F were analysed. An automatic environmental tobacco smoke emitter generated SHS in an enclosed space with a volume of 2.88 m3. PM was measured with a laser aerosol spectrometer (Grimm model 1.109). Afterwards, the measuring values of the four Lucky Strike brands and the reference cigarette were statistically evaluated and visualised.

RESULTS

Lucky Strike Straight Blue, a cigarette type without additives and lower tar amount, showed 10% to 25% lower PM mean values compared with the other tested Lucky Strike products, but 21% (PM1) respectively 27% (PM2.5,PM10) higher mean values than the reference cigarette. The PM mean of all measured smoke-free baseline values (clean air) was 1.6 µg/m³. It increased up to about 1800 µg/m³ for the reference cigarette and up to about 3070 µg/m³ for the Lucky Strike Original Blue.

CONCLUSIONS

The findings of this study show the massive increase of PM amount by smoking cigarettes in enclosed spaces and suggest that additives in tobacco products increase the PM amount in SHS. For validation, further comparative studies are necessary focusing on the comparison of the PM concentration of cigarettes with and without additives.

IMPLICATIONS

Due to the exposure to SHS, 890 000 people die each year worldwide. PM in SHS endangers the health of both non-smokers and smokers. This study considers the effect of additives like aromatics and humectant agents in cigarettes on PM in SHS. Do additives in tobacco products increase the amount of PM?

Indoor air pollution and exposure assessment of the gulf cooperation council countries: A critical review

Indoor air pollution is one of the human health threat problems in the Gulf Cooperation Council (GCC) countries. In these countries, due to unfavorable meteorological conditions, such as elevated ambient temperature, high relative humidity, and natural events such as dust storms, people spend a substantial amount of their time in indoor environments. In addition, production of physical and biological aerosols from air conditioners, cooking activities, burning of Arabian incense, and overcrowding due to pilgrimage programs are common causes of low quality indoor air in this region. Thus, due to infiltration of outdoor sources as well as various indoor sources, people living in the GCC countries are highly exposed to indoor air pollutants. Inhalation of indoor air pollutants causes mortalities and morbidities attributed to cardiorespiratory, pulmonary, and lung cancer diseases. Hence, the aim of this review study is to provide a summary of the major findings of indoor air pollution studies in different microenvironments in six GCC countries. These include characterization of detected indoor air pollutants, exposure concentration levels, source identifications, sustainable building designs and ventilation systems, and the mitigation strategies. To do so, >130 relevant indoor air pollution studies across the GCC countries were critically reviewed. Particulate matters (PM₁₀ and PM_2.5), total volatile organic compounds (TVOCs), carbon dioxide (CO₂), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and heavy metals were identified as the reported indoor air pollutants. Apart from them, indoor Radon and bioaerosols were studied only in specific GCC countries. Thus, future studies should also focus on the investigation of emerging indoor air pollutants, such as ultrafine and nanoparticles and their associated health effects. Furthermore, studies on the mitigation of indoor air pollution through the development of advanced air purification and ventilation systems could improve the indoor air quality (IAQ) in the GCC region.

Patterns of tobacco use in the United Arab Emirates Healthy Future (UAEHFS) pilot study

INTRODUCTION

Self-reported tobacco use in the United Arab Emirates is among the highest in the region. Use of tobacco products other than cigarettes is widespread, but little is known about specific behavior use patterns. There have been no studies that have biochemically verified smoking status.

METHODS

The UAE Healthy Future Study (UAEHFS) seeks to understand the causes of non-communicable diseases through a 20,000-person cohort study. During the study pilot, 517 Emirati nationals were recruited to complete a questionnaire, provide clinical measurements and biological samples. Complete smoking data were available for 428 participants. Validation of smoking status via cotinine testing was conducted based on complete questionnaire data and matching urine samples for 399 participants, using a cut-off of 200ng/ml to indicate active smoking status.

RESULTS

Self-reported tobacco use was 36% among men and 3% among women in the sample. However, biochemical verification of smoking status revealed that 42% men and 9% of women were positive for cotinine indicating possible recent tobacco use. Dual and poly-use of tobacco products was fairly common with 32% and 6% of the sample reporting respectively.

CONCLUSIONS

This is the first study in the region to biochemically verify tobacco use self-report data. Tobacco use in this study population was found to be higher than previously thought, especially among women. Misclassification of smoking status was more common than expected. Poly-tobacco use was also very common. Additional studies are needed to understand tobacco use behaviors and the extent to which people may be exposed to passive tobacco smoke.

IMPLICATIONS

This study is the first in the region to biochemically verify self-reported smoking status.

American pediatric society's 2017 John Howland award acceptance lecture: a tale of two toxicants: childhood exposure to lead and tobacco

This article summarizes the presentation of the 2017 Howland Award to Michael Weitzman, MD, at the Annual Pediatric Academic Society Meetings. It summarizes the remarkable advances in understanding the effects and pathways of exposure of the two most common and pernicious of our nation's child environmental exposures, namely lead and tobacco. It also summarizes the profound effect of the translation of these findings into prudent and effective clinical and public health policies such that exposure to both has dramatically decreased over the past 40 years due to the tenacious activities of pediatricians, other child-related professionals, government agencies at all levels, and the American Academy of Pediatrics. Research and clinical activities, although essential, were not sufficient to produce these successes, but required extensive mentoring to produce a generation of academic pediatricians capable of conducting the requisite research, and extensive advocacy by pediatricians and others to overcome the formidable inertia and outright opposition to efforts to protect our children from these exposures. Moreover, the article highlights that both of these environmental exposures have roots in social and environmental injustice and neither is solved, and that there is no safe level of exposure to either of these toxicants.

Tobacco Control and Treatment for the Pediatric Clinician: Practice, Policy, and Research Updates

Tobacco use is the leading cause of preventable death in the United States, and exposure to tobacco smoke harms children from conception forward. There is no safe level of tobacco exposure. Although overall smoking rates have declined, the advent of new products, such as electronic cigarettes, threatens to perpetuate nicotine addiction without clear health benefits. In addition to reviewing traditional and new tobacco products, we discuss the unique role that pediatricians should play in tobacco treatment and control efforts. New policies and technologies can empower pediatric clinicians and pediatric health care systems to help parent smokers quit, and new policies outside of the health care setting might help prevent smoking initiation as well as improve cessation treatments. Future research is needed to continue to study the consequences of tobacco use exposure as well as the best ways to help patients and parents stop tobacco use.